TELEHEALTH
AT JEFFERSON
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GAME ON FOR ANYTIME, ANYWHERE CARE
Photo by Karen Kirchhoff
FALL 2014/WINTER 2015 7
By Jessica Stein Diamond
ow that you can shop, socialize,
transact business and be entertained
basically anytime and anywhere, many
people have similar expectations for
virtual access to health care.
Jefferson is racing toward that future
with transformational initiatives using
mobile devices, laptops and personal
computers and other technologies to
offer patients remote access to care.
“We’re working to take the lead on where
medicine is going,” says Judd Hollander,
MD, associate dean for strategic health
initiatives at Jefferson. “Our goal is to
figure out how to create the health care
of the future.”
N
Story Summary
Ŕ Patients increasingly expect to receive
medical care 24/7 via mobile devices
and computers, a new practice environment often referred to as telehealth,
telemedicine or virtual medicine.
Ŕ This shift promises to improve access
to care within and beyond Jefferson’s
inpatient, outpatient and transitionalcare settings.
Ŕ Newly recruited clinician-scholars at
Sang H. Woo, MD, clinical associate professor of medicine and division
director of hospital medicine, leads rounds for patient Lily Chen. Chen’s
daughter participated virtually from California and was able to meet her
mother’s care providers and ask them questions about her condition.
Jefferson will lead research on virtual
medicine outcomes to identify best
practices likely to shape public policy
and influence insurance reimbursements. They will likewise shape
innovative new training and certification
programs for virtual medicine.
8 SIDNEY KIMMEL MEDICAL COLLEGE ALUMNI BULLETIN
"Jefferson will be at the forefront of
building the interactive patient
experience of the future." – John Kairys, MD ’88
Jefferson’s current and planned
enterprise-wide telehealth endeavors
reflect extensive input from patients,
patient advocates, physicians, allied
health professionals and senior health
system leadership. “We began with a
blank slate to find out how to provide
the right level of care anytime and
anywhere the patient wants it,” says
Hollander, who joined Jefferson in 2014
to help direct implementation plans
for telemedicine, otherwise known as
telehealth or (his preference) “medicine
without walls.” “Medicine has been
too often focused on what doctors and
nurses want and not on what patients
want. At Jefferson, the medicine of the
future is definitely going to be patient
centered.”
Beyond the Built Environment
Leveraging Jefferson’s clinical expertise
beyond its bricks and mortar presence
will take many forms and will incorporate evolving technologies as these
emerge. A subset of plans underway
includes: providing remote access to
medical care for Jefferson employees;
offering virtual access to multi-specialty
rounds for off-site family members
of hospitalized patients; enhancing
communication among patients and
care providers during and after hospital
discharge; and expanding the reach and
breadth of Jefferson’s remote stroke care
network to serve patients with other
critical care conditions. Concurrently,
Jefferson’s new National Academic
Center for Telehealth is pioneering critically needed research and training to
A patient follows instructions given by Robert
Rosenwasser, MD, during a virtual exam.
Photo by Karen Kirchhoff
FALL 2014/WINTER 2015 9
improve telemedicine healthcare practice
methods and outcomes.
“This initiative is still in its early
phases yet truly will be transformational,”
says John Kairys, MD ’88, senior vice
president and chief medical information
officer. “The changes underway reflect a
convergence of mobile technologies, video
conferencing, mobile health devices and
integration of electronic medical record
systems — plus an agreement among all
parties that we need to find a better way
to do things. Jefferson will be at the forefront of building the interactive patient
experience of the future.”
Tipping Point
Kairys points to an analysis by the
consulting firm Deloitte that identifies
2014 as the likely tipping point toward
adoption of virtual health care due to
widespread use of mobile technologies, especially among older patients,
and continued pressure to improve
care and reduce medical costs. Deloitte
projects there will be 75 million virtual
U.S. doctor visits in 2014, an estimated
one-fourth the potential U.S. market for
electronic doctor visits (and just a sliver
of the many ways patients will access
medical care remotely).
In keeping with Jefferson’s philosophy
of friends and family first, Jefferson
will begin offering its more than 17,000
employees and dependents virtual
access to unscheduled medical care
in 2015. This service will be available through an app accessible on any
internet-capable device. Employees
will be able to access virtual clinical
guidance and care around the clock
and obtain referrals, when needed, for
in-person primary care, specialists and
urgent or emergency care. “We’re happy
to begin our roll-out by offering our
employees the ability to tap into this
system,” says Hollander. “We plan to
expand this service in the future beyond
employees to other patients regionally
and ultimately nationally.”
Fan Favorite
Jefferson has also begun a pilot
program that offers virtual access to
multi-specialty rounds for hospitalized
patients. Family members click on an
app or link on a smartphone, tablet or
computer when rounds begin, listen
to the discussion and have a designated period of time when they can ask
questions. “We refer to this as the ‘fan
favorite’ among virtual medicine opportunities,” says Hollander.
While this virtual access is likely to
affect pacing for rounds, the additional
time needed will be factored in, says
Hollander. “We believe this is something
patients and family members will love.
The physician response has been ‘this
is great’ as well, because they recognize this will reduce the number of
phone calls and questions they need to
answer later in the day from patients’
family members.” Virtual rounds are
also expected to reduce hospital readmissions because families will be more
aware of the progress and course of a
patient’s treatment. This pilot began
on an oncology floor where a team of
engaged physicians and nurses assessed
workflow and technology issues;
they are now refining this new, more
patient-friendly virtual rounds process,
addressing issues iteratively as they
emerge.
“We want to make sure we’re doing
this well before we scale it up,” says
Hollander. “It would be great to reach
a point where every patient who comes
into the hospital could have their family
members present at virtual rounds.”
Virtual appointments to make sure
surgical incisions are healing properly
are another way Jefferson is using
technology to improve access. Kairys,
a practicing endocrine surgeon, sees
patients in his office up to two weeks
after a surgery. He typically offers a
second post-operative visit six to eight
weeks later. “That visit is primarily for
reassurance and takes just three to five
minutes,” he says. “I’m amazed at how
many people will take the day off from
work, drive into the city, pay $25 or more
for parking and wait in the waiting area
and patient room for that. Technology
gives us a wonderful opportunity to offer
that reassurance in a more time- and
cost-effective way. This also potentially
opens up more appointment slots so we
can then see additional patients and
further grow the practice.”
Jefferson neurosurgeons recently
began offering similar virtual follow-up
post-operative visits to check incision healing after surgeries such as
craniotomies. “If we can make this
work safely and successfully for a
10 SIDNEY KIMMEL MEDICAL COLLEGE ALUMNI BULLETIN
specialty like neurologic surgery, which
is resource intensive, high-acuity and
high-risk, then intuitively this should
work for other areas of medicine,” says
Robert Rosenwasser, MD, the Jewell L.
Osterholm Professor and Chair of the
Department of Neurological Surgery and
steering committee member for the telehealth program.
Bridge Communication Gaps
Family members
click on an app
or link on a smartphone, tablet or
computer when
rounds begin,
listen to the
discussion and
have a designated
period of time
when they can
ask questions.
Virtual house calls and virtual discharge
rounds are also being developed and
will likely be offered by Jefferson within
a year to improve post-transition care
after hospitalization or surgery. Using
a yet-to-be-determined technology, this
would bridge communication gaps among
primary care doctors, home healthcare
workers and family members for instance
for heart failure and other high-risk
patients. Anticipated outcomes include
improved community-based care, better
medication and medical records continuity and decreased readmission rates.
Parallel to these transformative telemedicine initiatives, Jefferson’s Board of
Trustees has approved implementation
of Epic software to replace the majority
of its enterprise-wide medical records
systems. “This is an exciting and challenging time,” says Kairys, noting that
each virtual medicine use case integrates with both the current and the
future infrastructure, which will also
eventually integrate data from mobile
health devices such as Apple’s HealthKit.
“Our greatest challenge is to learn how
to extract the value of the truly important data from the background noise,”
he says. “The winners in this game will
be those organizations that recognize
data and present it to caregivers and
patients in ways that are meaningful and
actionable.”
In this changing environment —
with new technologies and corporate
alliances also evolving — Jefferson’s
commitment to providing highquality patient care remains constant.
Jefferson’s new National Academic
Center for Telehealth has recently
recruited several clinician-scholars,
including Kristin Rising, MD, and
Brendan Carr, MD, who will lead foundational research to identify best practices
in virtual medicine and amass the
solid base of evidence needed to shape
delivery and funding justification for this
emerging mode of healthcare delivery.
Recruiting Advantage
Jefferson’s Institute for Emerging Health
Professions is likewise rapidly developing
training programs, fellowships, certificate and continuing medical education
programs, apps and online resources.
“Our expertise in the education needed
for virtual health care is emerging as a
major recruiting advantage for Jefferson,”
says Hollander. “We’re confronting the
question head-on of whether our people
will be trained in the medicine practiced
in 1985, 2014 or 2025.”
Amid this rapid pace of change, “the
major challenge is to take the 8 million
ideas flying at those of us leading this
effort and decide which ones we do
when,” says Hollander. “You just can’t sit
in your office figuring out your corporate strategy based on what you want to
do or make decisions based on current
technology. Academic medical centers,
hospitals and private practices have long
existed in an environment that said, ‘you
play by my rules and come see me when
I want to see you.’ That’s just not going
to work anymore.”
“The bottom line is that if you want to
be practicing medicine, provide better
care for your patients and be the entity
people want to go to for health care 10
years from now, you have to move the
needle,” he says. “Everybody realizes
this is the Jefferson of the future.”
Jefferson alumni who would like to explore opportunities to provide
care virtually may contact Kate Fuller, program manager, at
kate.fuller@jefferson.edu for additional information.
FALL 2014/WINTER 2015 11
Jefferson Neuroscience Network: Inspiration for
Virtual Expansion
Charlyn Kiley, 68, remembers the onset of her acute stroke in February 2014.
Moments after finishing a Spam sandwich, a cup of coffee and a cigarette,
she noticed that her speech sounded garbled and her left side felt heavy.
A resident of East Stroudsburg, Pa., she lives more than 100 miles from an
accredited primary stroke center.
Soon after, Kiley arrived at Pocono Medical Center and spoke through a
screen to an attending physician with Jefferson’s Neuroscience Network
who assessed and directed her care team virtually so that she received timely
treatment for an acute ischemic stroke with clot-busting tissue plasminogen
activator, or tPA. Less than a year later, she is relieved to have regained her
ability to speak clearly, put curlers in her hair, walk her dog and enjoy her
favorite pastime, fishing. “It would be misery to not be able to walk or talk,”
Kiley says. “And it wasn’t bad talking to a doctor through a screen. That was
pretty cool.”
Kiley is among the more than 5,000 stroke patients at 30 participating
regional hospitals in Pennsylvania, New Jersey and Delaware who have
received care virtually through the Jefferson Neuroscience Network.
Established in 2009 by Robert Rosenwasser, MD, chair of neurological
surgery, the network serves acute stroke patients who live hours away from
hospitals that offer 24/7 stroke care.
“This has been nothing but a tremendous success for the patients, our
partner hospitals and Jefferson,” says Rosenwasser, medical director of the
network, which is staffed around the clock by 11 attending vascular neurosurgeons, vascular neurologists and neuro critical care specialists who
routinely save lives and prevent disability. They are virtually present at the
bedside in participating hospitals through a robot-like device with a screen.
Ninety-seven percent of Jefferson Neuroscience Network’s eligible
patients received tPA within the recommended window of three hours
from stroke onset — a vast improvement over the 3 to 5 percent of eligible
patients who receive this therapy nationally. Because the ability to distinguish
between an ischemic or hemorrhagic stroke is a life-and-death matter, an
estimated 65 percent of physicians nationally feel uncomfortable prescribing
tPA without a specialist consultation: use of tPA for a hemorrhagic stroke
would increase bleeding and brain damage.
Responding to requests from the network’s participating hospitals, in
2015 Jefferson will begin offering additional critical care specialty expertise
services at some of these hospitals, which collectively log more than 1.5
million emergency room visits annually (not just for stroke). This expanded
network will be staffed by senior, board-certified attending physicians who
will speak directly to patients and on-site medical teams at the bedside. This
strategic expansion will allow Jefferson to amass foundational evidence and
experience for a possible future virtual Jefferson emergency department.
According to Rosenwasser, an appointee to the Pennsylvania Telemedicine
Roundtable, expertise in remote specialty consults is of keen interest in
Pennsylvania, where Medicaid spending on transportation alone is $90
million annually. “When you treat the patient, keep them in their community
cared for by their local physician and hospital and still deliver a high level of
care, everybody wins,” he says, noting that the network has already helped
seven participating hospitals become accredited as primary stroke centers.
Jefferson neuroscience specialists can evaluate
acute stroke patients at community hospitals
virtually using robotic devices like this one.